Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA.
Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
Ann Otol Rhinol Laryngol. 2022 Aug;131(8):914-917. doi: 10.1177/00034894211047459. Epub 2021 Sep 18.
Implanted vagal nerve stimulators (VNS) are an accepted therapy for refractory seizures. However, VNS have been shown to affect vocal fold function, leading to voice complaints of hoarseness. We present a case of intermittent VNS-related vocal fold paralysis leading to dysphonia and dysphagia with aspiration in a pediatric patient.
This is a case report of a patient at a tertiary hospital evaluated in pediatric swallow and voice clinics. Patient and mother gave verbal consent to be included in this case report.
Indirect laryngeal stroboscopy was performed demonstrating full vocal fold mobility with VNS off and left vocal fold paralysis in lateral position and glottic gap with VNS on. Voice measures were performed demonstrating decreased phonation time, lower pitch, and decreased intensity of voice with VNS on. Flexible endoscopic evaluation of swallowing demonstrated deep penetration alone with VNS off and deep penetration with concern for aspiration with VNS on.
While the majority of cases of vocal fold movement impairment associated with VNS have been noted to have a medialized vocal fold with VNS activation, we describe a case of intermittent vocal fold lateralization associated with VNS activation with resultant voice changes and aspiration.
植入式迷走神经刺激器（VNS）是治疗难治性癫痫的一种公认的疗法。然而，已经证明 VNS 会影响声带功能，导致声音嘶哑等嗓音投诉。我们报告了一例儿科患者间歇性 VNS 相关声带麻痹导致发音困难和吞咽困难伴吸入的病例。
这是一家三级医院的患者在儿科吞咽和语音诊所进行评估的病例报告。患者及其母亲口头同意将其纳入本病例报告。
间接喉镜检查显示 VNS 关闭时声带完全活动，左侧声带在侧位时麻痹，声带间隙在 VNS 开启时张开。嗓音测量显示 VNS 开启时发音时间缩短、音调低、嗓音强度降低。吞咽的灵活内镜评估显示 VNS 关闭时仅出现深度渗透，而 VNS 开启时则出现深度渗透伴吸入的风险。
虽然大多数与 VNS 相关的声带运动障碍病例都被认为是 VNS 激活时声带向内侧移位，但我们描述了一例与 VNS 激活相关的间歇性声带侧移病例，导致声音改变和吸入。
